Abstract
The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa. We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression. We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3-3·8) in general populations, 2·8% (1·0-5·2) in intermediate-risk populations, 13·2% (7·2-20·7) in female sex workers, 11·3% (9·0-13·7) in infertility clinic attendees, 12·4% (7·9-17·7) in women with miscarriage, 12·4% (9·4-15·7) in symptomatic women, and 17·4% (12·5-22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2-12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018. C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region. National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).
Highlights
With more than 100 million incident infections every year,[1] Chlamydia trachomatis is one of the most common sex ually transmitted infections (STIs) worldwide.[2,3] curable, control and early detection of C trachomatis infection are challenged by its largely asymptomatic nature.[4]
Untreated C trachomatis infection is associated with serious reproductive tract conditions including pelvic inflammatory disease, ectopic pregnancy, infertility among women, and epididymitis among men.[5,6]
Added value of this study Using rigorous state-of-the-art methodologies with current empirical evidence, this study provided the first comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa
Summary
With more than 100 million incident infections every year,[1] Chlamydia trachomatis is one of the most common sex ually transmitted infections (STIs) worldwide.[2,3] curable, control and early detection of C trachomatis infection are challenged by its largely asymptomatic nature.[4]. STI control has long languished on health policy agendas. The 2030 Agenda on Sustainable Development[7] aims to remedy this situation and led to WHO’s Global Health Sector Strategy on STIs.[8] The strategy proposes an integrated approach for STI prevention and control that addresses core Sustainable Development Goals, mainly through securing universal access to sexual and reproductive health-care services and rights.[7,8] The first strategic direction of this STI Strategy is “the need to understand the sexually transmitted infection epidemic and response as a basis for advocacy, political commitment, national planning, resource mobilization and allocation, implementation, and programme improvement.”[8]
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